About Us
Inform Diagnostics, a Fulgent Genetics Company, is a nationally recognized diagnostics laboratory focused on anatomic pathology subspecialties including gastrointestinal pathology, dermatopathology, urologic pathology, hematopathology, and breast pathology.
Founded in 2011, our parent entity, Fulgent Genetics, has evolved into a premier, full-service genomic testing company built around a foundational technology platform.
Through our diverse testing menu, Fulgent is focused on transforming patient care in oncology, anatomic pathology, infectious and rare diseases, and reproductive health. We believe that by providing a wide range of effective, flexible testing options in conjunction with best-in-class service and support, we can redefine the way medicine is managed for patients and clinicians alike.
Since integrating with our therapeutic development business, Fulgent is also developing drug candidates for treating a broad range of cancers using a novel nanoencapsulation and targeted therapy platform. By merging our fields of expertise, we aim to become a fully integrated precision medicine company.
Summary of Position
Our Specialist will interact with patients, insurance carriers, medical facilities, and providers on a daily basis to ensure a seamless front-end benefits verification, coordination and authorization process for all tests. Our Specialist is responsible for providing excellent service by responding to questions from patients, clerical staff, and insurance companies, as well as identifying and resolving patient billing complaints. The Patient Benefits Specialist will review accounts for billing accuracy in order to maximize reimbursement. The Patient Benefits Specialist will have strong attention to detail with the aptitude to learn our medical billing and collections process specifically eligibility verification and prior authorization processes. Our Specialist is responsible to work, research, and resolve front end errors. The mission of the Specialist is to provide excellent customer service and performs a wide variety of complex patient benefits investigation, coordination, and billing duties.
Key Job Elements
- Communicates with various regional and national payers, including Federal, State, Third Party (HMO,PPO, IPA, TPA Indemnity) to validate health plan eligibility, benefits, deductibles and maintains accurate documentation.
- Serves as the point of contact for patients to ensure accurate communication of health plan benefits and eligibility and answers all patient concerns regarding coverage and billing details.
- Coordinates all patient and insurance billing for the medical laboratory; ensures that patient information is entered accurately, verify patient insurance eligibility and benefits, submit prior authorizations and submit clean claims to insurance companies on a daily basis.
- Reviews physician referrals for completeness and accuracy ensuring the referral includes patient information, diagnosis code, type of service, physician signature, date and authorization number is required. Faxes referral to referring physician if information is incomplete.
- Establishes payment plans to help patients manage their payments, provide customer service to patients.
- Prepares, reviews, and transmits claims using billing software, including electronic and paper claim processing.
- Confirms patient demographic, insurance and referring physician information is accurately entered into system.
- Identifies and bills secondary or tertiary insurances.
- Provides case progress, insurance inquiry and reimbursement report to management.
- Maintains contact with patients and medical facilities and provides updates on authorization progress and case processing status.
- Maintains patient confidentiality as per the Health Insurance Portability and Accountability Act of1996 (HIPPA).
- Performs other related duties or special projects as assigned.
